Health Care Fraud Prosecutions On The Rise

In the last few years, many healthcare providers have come under increased scrutiny from federal and state investigative and auditing agencies. The recent USAToday article confirms that the federal government stepped up the prosecution of health care fraud. In fact, according to USAToday “[n]ew government statistics show federal health care fraud prosecutions in the first eight months of 2011 are on pace to rise 85% over last year due in large part to ramped-up enforcement efforts under the Obama administration.”

Aiding the federal prosecutors are changes and additions made to federal laws in 2009, with the passage of the Fraud Enforcement and Recovery Act (FERA), and in 2010, with the passage of the Patient Protection and Affordable Care Act (PPACA). Both laws expanded and strengthened the government’s abilities to prosecute healthcare providers for alleged violations of federal laws. Increased budgets further strengthen the prosecutors’ agenda to weed out fraud and combat abuse and inefficient practices by allowing for the hiring of additional personnel, greater cooperation between agencies, law enforcement officials, state agencies and private insurance companies.

The increased attention from the federal government comes at a time when state healthcare agencies are also conducting their own investigations of healthcare providers, particularly Medicaid providers, in hopes of increasing recoveries to state coffers.